Timing of milk expression following delivery in mothers delivering preterm very low birth weight infants: a randomized trial

Abstract

Objective

To determine the effect of timing of expression initiation on mother’s own milk production and time to secretory activation in mothers of preterm infants.

Study design

180 mothers delivering infants ≤1500 grams and ≤32 weeks gestation were randomized to begin expression within 60 (early), 61–180 (intermediate) or 181–360 (late) minutes following delivery. Milk volume was measured on days 1–7 and weekly for 6 weeks. Time to secretory activation was determined through self-report.

Results

The late group produced more milk than the early group in the first 3 days (p = 0.015–0.031) and over 6 weeks (p = 0.045). The late group had more expressions on day 1 (early: p = 0.049; intermediate; p = 0.048).

Conclusion

Initiation of expression at 181–360 min following delivery was associated with increased milk production for 6 weeks following delivery. Further research is needed to determine the effect of expression frequency on milk production in the first days following birth.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1
Fig. 2

References

  1. 1.

    Cortez J, Makker K, Kraemer DF, Neu J, Sharma R, Hudak ML. Maternal milk feedings reduce sepsis, necrotizing enterocolitis and improve outcomes of premature infants. J Perinatol. 2018;38:71–4.

    CAS  PubMed  Google Scholar 

  2. 2.

    Corpeleijn WE, Kouwenhoven SM, Paap MC, van Vliet I, Scheerder I, Muizer Y, et al. Intake of own mother’s milk during the first days of life is associated with decreased morbidity and mortality in very low birth weight infants during the first 60 days of life. Neonatology. 2012;102:276–81.

    CAS  PubMed  Google Scholar 

  3. 3.

    Luo X, Zhai S, Shi N, Li M, Cui S, Xu Y, et al. The risk factors and neonatal outcomes of isolated single umbilical artery in singleton pregnancy: a meta-analysis. Sci Rep. 2017;7:7396.

    PubMed  PubMed Central  Google Scholar 

  4. 4.

    Huang J, Zhang L, Tang J, Qu Y, Xiong T, Mu D, et al. Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2018;2:F128–36.

    Google Scholar 

  5. 5.

    Patel AL, Johnson TJ, Engstrom JL, Fogg LF, Jegier BJ, Bigger HR, et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol. 2003;33:514–9.

    Google Scholar 

  6. 6.

    Fabiyi C, Rankin K, Norr K, Yoder JC, Vasa R, White-Traut R. The association of low social support with breast milk expression in low-income mother-preterm infant dyads. J Hum Lactation. 2015;31:490–7.

    Google Scholar 

  7. 7.

    Parker LA, Sullivan S, Krueger C, Kelechi T, Mueller M. Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study. J Perinatol. 2012;32:205–9.

    CAS  PubMed  Google Scholar 

  8. 8.

    Hill PD, Aldag JC, Chatterton RT, Zinaman M. Comparison of milk output between mothers of preterm and term infants: the first 6 weeks after birth. J Hum Lactation. 2005;21:22–30.

    Google Scholar 

  9. 9.

    Cregan MD, De Mello TR, Kershaw D, McDougall K, Hartmann PE. Initiation of lactation in women after preterm delivery. Acta obstetricia et gynecologica Scandinavica. 2002;81:870–7.

    PubMed  Google Scholar 

  10. 10.

    Brownell E, Howard CR, Lawrence RA, Dozier AM. Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatrics. 2012;161:608–14.

    Google Scholar 

  11. 11.

    Maastrup R, Hansen BM, Kronborg H, Bojesen SN, Hallum K, Frndson A, et al. Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study. PloS One. 2014;9:e89077.

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Bonet M, Blondel B, Agostino R, Combier E, Maien RF, Cuttini M, et al. Variations in breastfeeding rates for very preterm infants between regions and neonatal units in Europe: results from the MOSAIC cohort. Arch Dis Child Fetal Neonatal Ed. 2011;96:F450–2.

    PubMed  Google Scholar 

  13. 13.

    Berkhout DJC, Klaassen P, Niemarkt HJ, de Boode WP, Cossey V, van Goudoeyer JB, et al. Risk factors for necrotizing enterocolitis: a prospective multicenter case-control study. Neonatology. 2018;114:277–84.

    PubMed  Google Scholar 

  14. 14.

    Battersby C, Longford N, Mandalia S, Costeloe K, Modi N. Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012-13: a whole-population surveillance study. lancet Gastroenterol Hepatol. 2017;2:43–51.

    PubMed  Google Scholar 

  15. 15.

    Casavale KO, Ahuja JKC, Wu X, Li Y, Quam J, Olson R, et al. NIH workshop on human milk composition: summary and visions. Am J Clin Nutr. 2019;3:769–79.

    Google Scholar 

  16. 16.

    Wall EH, Crawford HM, Ellis SE, Dahl GE, McFadden TB. Mammary response to exogenous prolactin or frequent milking during early lactation in dairy cows. J Dairy Sci. 2006;89:4640–8.

    CAS  PubMed  Google Scholar 

  17. 17.

    Wall EH, McFadden TB. The milk yield response to frequent milking in early lactation of dairy cows is locally regulated. J Dairy Sci. 2007;90:716–20.

    CAS  PubMed  Google Scholar 

  18. 18.

    Hale SA, Capuco AV, Erdman RA. Milk yield and mammary growth effects due to increased milking frequency during early lactation. J Dairy Sci. 2003;86:2061–71.

    CAS  PubMed  Google Scholar 

  19. 19.

    Murase M, Nommsen-Rivers L, Morrow AL, Hatsuno M, Mizuna K, Taki M, et al. Predictors of low milk volume among mothers who delivered preterm. J Hum Lactation. 2014;30:425–35.

    Google Scholar 

  20. 20.

    Bishara R, Dunn MS, Merko SE, Darling P. Volume of foremilk, hindmilk, and total milk produced by mothers of very preterm infants born at less than 28 weeks of gestation. J Hum Lactation. 2009;25:272–9.

    Google Scholar 

  21. 21.

    Hill PD, Aldag JC, Chatterton RT, Zinaman M. Primary and secondary mediators’ influence on milk output in lactating mothers of preterm and term infants. J Hum Lactation. 2005;21:138–50.

    Google Scholar 

  22. 22.

    Parker LA, Sullivan S, Krueger C, Mueller M. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med. 2015;10:84–91.

    PubMed  PubMed Central  Google Scholar 

  23. 23.

    Furman L, Minich N, Hack M. Correlates of lactation in mothers of very low birth weight infants. Pediatrics. 2002;109:e57.

    PubMed  Google Scholar 

  24. 24.

    Haase B, Barreira J, Murphy PK, Mueller M, Rhodes J. The development of an accurate test weighing technique for preterm and high-risk hospitalized infants. Breastfeed Med. 2009;4:151–6.

    PubMed  Google Scholar 

  25. 25.

    Rankin MW, Jimenez EY, Caraco M, Collinson M, Lostetter L, DuPont TL. Validation of test weighing protocol to estimate enteral feeding volumes in preterm infants. J Pediatrics. 2016;178:108–12.

    Google Scholar 

  26. 26.

    Chapman DJ, Perez-Escamilla R. Maternal perception of the onset of lactation is a valid, public health indicator of lactogenesis stage II. J Nutr. 2000;130:2972–80.

    CAS  PubMed  Google Scholar 

  27. 27.

    Perez-Escamilla R, Chapman DJ. Validity and public health implications of maternal perception of the onset of lactation: an international analytical overview. J Nutr. 2001;131:3021S–3024S.

    CAS  PubMed  Google Scholar 

  28. 28.

    Meier PP, Engstrom JL, Janes JE, Jegier BJ, Loera F. Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol. 2012;32:103–10.

    CAS  PubMed  Google Scholar 

  29. 29.

    Hill PD, Aldag JC, Demirtas H, Zinaman M, Chatterton RT. Mood states and milk output in lactating mothers of preterm and term infants. J Hum Lactation. 2006;22:305–14.

    Google Scholar 

  30. 30.

    Smith VA, Preisser JS, Neelon B, Maciejewski ML. A marginalized two-part model for semicontinuous data. Stat Med. 2014;33:4891–903.

    PubMed  Google Scholar 

  31. 31.

    Smith VA, Neelon B, Preisser JS, Maciejewski ML. A marginalized two-part model for longitudinal semicontinuous data. Stat Methods Med Res. 2017;26:1949–68.

    PubMed  Google Scholar 

  32. 32.

    Voronca D, Gebregziabher M, Durkalski V, Liu L, Egede L. Marginalized two part models for generalized gamma family of distributions. 2015;arXiv:1511.05629.

  33. 33.

    Akaike H. A new look at the statistical model identification. IEEE Trans Autom Control. 1974;19:716–23.

    Google Scholar 

  34. 34.

    Nakao Y, Moji K, Honda S, Oishi K. Initiation of breastfeeding within 120 min after birth is associated with breastfeeding at four months among Japanese women: a self-administered questionnaire survey. Int Breastfeed J. 2008;3:1.

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    Chien LY, Tai CJ. Effect of delivery method and timing of breastfeeding initiation on breastfeeding outcomes in Taiwan. Birth (Berkeley, Calif). 2007;34:123–30.

    Google Scholar 

  36. 36.

    Hopkinson JM, Schanler RJ, Garza C. Milk production by mothers of premature infants. Pediatrics. 1988;81:815–20.

    CAS  PubMed  Google Scholar 

  37. 37.

    Hoban R, Patel AL, Medina Poeliniz C, Lai CT, Janes J, Geddes D, et al. Human milk biomarkers of secretory activation in breast pump-dependent mothers of premature infants. Breastfeed Med. 2018;13:352–60.

    PubMed  Google Scholar 

  38. 38.

    Patel AL, Johnson TJ, Engstrom JL, Fogg LF, Jegier BJ, Bigger HR, et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinat. 2013;33:514–9.

    CAS  Google Scholar 

  39. 39.

    Chollet-Hinton LS, Stuebe AM, Casbas-Hernandez P, Chetwynd E, Troester MA. Temporal trends in the inflammatory cytokine profile of human breastmilk. Breastfeed Med. 2014;9:530–7.

    PubMed  PubMed Central  Google Scholar 

  40. 40.

    Wilson E, Christensson K, Brandt L, Altman M, Bonamy AK. Early provision of mother’s own milk and other predictors of successful breast milk feeding after very preterm birth: a regional observational study. J Hum Lactation. 2015;31:393–400.

    Google Scholar 

  41. 41.

    Purdy IB, Singh N, Le C, Bell C, Whiteside C, Collins M. Biophysiologic and social stress relationships with breast milk feeding pre- and post-discharge from the neonatal intensive care unit. J Obstet Gynecologic Neonatal Nurs. 2012;41:347–57.

    Google Scholar 

  42. 42.

    Acuna-Muga J, Ureta-Velasco N, de la Cruz-Bertolo J, Ballesteros-Lopez R, Sanchez-Martinez R, Miranda-Casabona E, et al. Volume of milk obtained in relation to location and circumstances of expression in mothers of very low birth weight infants. J Hum Lactation. 2014;30:41–6.

    Google Scholar 

  43. 43.

    Lee HC, Gould JB. Factors influencing breast milk versus formula feeding at discharge for very low birth weight infants in California. J Pediatrics. 2009;155:657–62. e651-652

    Google Scholar 

  44. 44.

    Cordero L, Valentine CJ, Samuels P, Giannone PJ, Nankervis CA. Breastfeeding in women with severe preeclampsia. Breastfeed Med. 2012;7:457–63.

    PubMed  Google Scholar 

  45. 45.

    Sisk P, Quandt S, Parson N, Tucker J. Breast milk expression and maintenance in mothers of very low birth weight infants: supports and barriers. J Hum Lactation. 2010;26:368–75.

    Google Scholar 

  46. 46.

    Omarsdottir S, Adling A, Bonamy AK, Legnevall L, Tessma MK, Vanpee M. Predictors of sustained maternal milk feeds in extremely preterm infants. J Perinat. 2015;35(5):367–72.

    CAS  Google Scholar 

  47. 47.

    Tie WJ, Gardner H, Lai CT, Hepworth AR, Al-Tamini Y, Paech MJ, et al. Changes in milk composition associated with pethidine-PCEA usage after Caesarean section. Matern Child Nutr. 2017;13:e12275.

    Google Scholar 

Download references

Funding

This work was supported by a grant 1 R15 NR013566-01A1 from the National Institute of Nursing Research.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Leslie A. Parker.

Ethics declarations

Conflict of interest

LAP, SS, CK and MM’s work has been funded by the NIH. None of the authors have additional conflict of interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Parker, L.A., Sullivan, S., Kruger, C. et al. Timing of milk expression following delivery in mothers delivering preterm very low birth weight infants: a randomized trial. J Perinatol 40, 1236–1245 (2020). https://doi.org/10.1038/s41372-020-0688-z

Download citation

Further reading

Search

Quick links